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Litigation on Third Party Prescription Programs: An Update
Published online by Cambridge University Press: 28 April 2021
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The American health care system is currently engaged in one of the most profound transitions in recent history. Demands for cost containment propel this transition, catalyzed by third party payers—federal and state governments, Blue Cross/Blue Shield, private insurers, third party administrators, and employers. The era of usual and customary compensation for health care providers participating in third party programs may be rapidly ending. Pharmacy witnessed the demise of usual and customary compensation in the early 1960s and has been fighting to regain it since then.
In recent years, third party prescription programs (TPPPs) have been the subject of, or have been affected by, various lawsuits, rulings by the Federal Trade Commission (FTC), and state attorney general opinions. Most have not been favorable for pharmacists. In a previous article in Law, Medicine & Health Care, this author explored some of the litigation and legislation which pharmacists attempted as a means to solve the problems presented by TPPPs.
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References
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